Download Chapter 4 - Denali Rx

Chapter 4
Dosage Forms and
Routes of Administration
© Paradigm Publishing, Inc.
1
Solid Dosage Forms
• A dosage form is the physical
manifestation of a drug:
– Solid
– Liquid
– Gas
• Drug delivery system affects how the
drug is released in the body.
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Terms to Remember
dosage form
the physical manifestation of a drug
(e.g., capsule, tablet)
drug delivery system
a design feature of the dosage form that
affects the delivery of the drug; may
protect the stomach or delay the release
of the active drug
© Paradigm Publishing, Inc.
3
Solid Dosage Forms
Safety Note
Although tablets and capsules may
have distinctive markings and
colors, the pharmacy technician
should rely on the drug label and
the NDC (National Drug Code)
number, not the look of the
medication, when confirming the
identity of a drug.
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Solid Dosage Forms
•
•
•
•
Tablets
Capsules
Lozenges, Troches, or Pastilles
Powders and Granules
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Tablets
• Available in a variety of sizes and
shapes
• Produced by compression
• Contain one or more active
ingredients plus inactive ingredients
(see Table 4.1)
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Tablets
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Tablets
Multiple compression tablet (MCT) is
either a
– Tablet on top of another tablet, or
– Tablet within a tablet
– Core and shells or layers
each contain different
medicine
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Terms to Remember
tablet
the solid dosage form produced by
compression and containing one or
more active and inactive ingredients
multiple compression tablet (MCT)
a tablet formulation on top of a tablet or
a tablet within a tablet, produced by
multiple compressions in manufacturing
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Tablets
• Caplet just tablet shaped like capsule
• Solid interior, unlike capsule
• Advantages
– Easier to swallow than large
tablet
– Longer shelf-life than
capsule
– More tamper-proof than
capsule
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Tablets
• Chewable tablets contain a flavored
and/or colored base:
– Antacids
– Antiflatulents
– Vitamins
– Children’s tablets
• Oral disintegrating tablets (ODT) melt
in the mouth; preferred for those who
have difficulty swallowing
© Paradigm Publishing, Inc.
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Terms to Remember
caplet
a hybrid solid dosage formulation
sharing characteristics of both a tablet
and a capsule
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Terms to Remember
chewable tablet
a solid oral dosage form meant to be
chewed; readily absorbed; commonly
prescribed for school-age children
oral disintegrating tablet (ODT)
a solid oral dosage form designed to
dissolve quickly on the tongue for oral
absorption and ease of administration
without water
Tablets
Coatings can be used to improve
– Appearance
– Flavor
– Ease of swallowing
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Tablets
Common tablet coatings
– Sugar-coated tablet (SCT): improves
taste and appearance; easier to swallow
– Film-coated tablet (FCT): improves
appearance; can lessen side effects
– Enteric-coated tablet (ECT): designed to
bypass stomach and be absorbed in
small intestine
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Tablets
Safety Note
ECT or delayed-release tablets
should not be split.
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Capsules
• Consist of a gelatin shell that
encloses the drug
• Contain powders, granules, or liquids
• May also contain
– Inert filler (diluent)
– Disintegrants
– Solubilizers
– Preservatives
© Paradigm Publishing, Inc.
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Terms to Remember
capsule
the dosage form containing powder,
liquid, or granules in a gelatin covering
diluent
an inactive ingredient that allows for the
appropriate concentration of the
medication in the tablet or capsule; also
used to reconstitute parenteral products
© Paradigm Publishing, Inc.
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Capsules
• Most tablets and capsules are
immediate-release.
• Some are not immediate-release:
– Controlled-release: intended to regulate
the rate at which a drug is released
– Sustained-release (SR): dosing reduced
from immediate-release
– Extended-release : dosing reduced from
immediate-release and most sustainedrelease forms
© Paradigm Publishing, Inc.
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Terms to Remember
controlled-release dosage form
the dosage form that is formulated to
release medication over a long duration
of time; also called delayed release
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Terms to Remember
sustained-release (SR) dosage form
a delayed-release dosage form that
allows less frequent dosing than an
immediate-release dosage form
extended-release (XL) dosage form
a tablet or capsule designed to reduce
frequency of dosing compared with
immediate-release and most sustainedrelease forms
Capsules
Safety Note
Watch drug labels very carefully! A
sustained-release (SR) dosage form
is not the same as an extendedrelease (XL) dosage form of the
same drug.
© Paradigm Publishing, Inc.
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Lozenges, Troches,
or Pastilles
• Contain active ingredients and
flavorings that are dissolved in the
mouth
• Usually have a local therapeutic effect
• Examples include
– OTC lozenges for sore throat
– Prescription drugs such as nystatin or
clotrimazole
– Some narcotic medications
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Terms to Remember
lozenge
a medication in a sweet-tasting
formulation that is absorbed in the
mouth
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Powders and Granules
• Powders are milled and pulverized by
machines.
• Examples include
– Bacitracin zinc
– Antacids
– Brewer’s yeast
– Laxatives
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Powders and Granules
• Granules are larger than powders.
• Granules are formed by adding small
amounts of water to powders.
• Granules can be compressed into
tablets or enclosed in capsules.
• Granules generally have
– An irregular shape
– Excellent flow characteristics
– Greater stability than powders
© Paradigm Publishing, Inc.
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Powders and Granules
• Effervescent salts are coarse
powders or granules containing both
– Medicinal agent(s)
– Sodium bicarbonate with an acid
• When dissolved in water, effervescent
salts release carbon dioxide gas,
causing distinctive bubbling.
© Paradigm Publishing, Inc.
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Terms to Remember
powders
fine particles of medication used in
tablets and capsules
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Terms to Remember
granules
a dosage form larger than powders that
is formed by adding very small amounts
of liquid to powders
effervescent salts
granular salts that release gas and
dispense active ingredients into solution
when placed in water
Semisolid Dosage Forms
• An emulsion is a mixture of two
unblendable substances.
• An oil-in-water emulsion contains a
small amount of oil dispersed in water
as a cream or lotion.
• A water-in-oil emulsion contains a
small amount of water dispersed in oil
as an ointment.
© Paradigm Publishing, Inc.
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Semisolid Dosage Forms
•
•
•
•
Ointments
Creams
Gels
Suppositories
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Ointments
• Can be medicated or nonmedicated
• May contain various bases
– Oleaginous, such as mineral oil or
petroleum jelly
– W/O emulsions such as lanolin or cold
cream
– O/W emulsions such as hydrophilic
ointment
– Water-soluble bases such as
polyethylene glycol
© Paradigm Publishing, Inc.
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Terms to Remember
ointment
a semisolid emulsion for topical use on
the skin
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Ointments
• A paste is like an ointment but with
more solids, such as zinc oxide paste.
• A plaster is a preparation that
adheres to the body and contains a
backing material.
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Terms to Remember
liniment
a medicated topical preparation for
application to the skin, such as Ben Gay
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Terms to Remember
paste
a water-in-oil (W/O) emulsion containing
more solid material than an ointment
plaster
a solid or semisolid, medicated or nonmedicated preparation that adheres to
the skin
Creams
• Creams are a O/W emulsion and are
usually invisible once applied.
• Lotions are topical O/W emulsions
that are easily absorbed:
– Calamine lotion (to relieve itching)
– Benzoyl peroxide (for acne)
© Paradigm Publishing, Inc.
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Terms to Remember
cream
a cosmetically acceptable oil-in-water
(O/W) emulsion for topical use on the
skin
lotion
a liquid for topical application that
contains insoluble dispersed solids or
immiscible liquids
© Paradigm Publishing, Inc.
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Gels
• A gel contains solid particles in liquid.
• A jelly is a type of gel that contains a
higher proportion of water.
• A glycerogelatin is a topical
preparation made with gelatin,
glycerin, water, and medicine.
© Paradigm Publishing, Inc.
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Suppositories
• Have a base of cocoa butter or
glycerin
• Are designed to melt when inserted
into a body orifice, such as the rectum
or vagina
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Liquid Dosage Forms
• Consist of one or more active
ingredients in a liquid vehicle
• Often less stable than solids
• Allow easier dosage adjustments
• Often used for children’s medication –
can be flavored to improve
compliance
© Paradigm Publishing, Inc.
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Liquid Dosage Forms
• Solutions
• Dispersions
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Solutions
• Active ingredients are completely
dissolved in liquid vehicle:
– Aqueous (water-based)
– Alcoholic (alcohol-based)
– Hydroalcoholic (water-and-alcoholbased)
• Solute is the active ingredient.
• Solvent is the liquid vehicle.
© Paradigm Publishing, Inc.
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Terms to Remember
solution
a liquid dosage form in which the active
ingredients are completely dissolved in a liquid
vehicle
solute
an ingredient dissolved in a solution or
dispersed in a suspension
solvent
the vehicle that makes up the greater part of a
solution
© Paradigm Publishing, Inc.
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Solutions
• Aromatic water is a solution of water and
oils that are easily released into the air
(e.g., rose water).
• An elixir is a clear, sweetened, flavored
solution containing ethanol and an active
ingredient (phenobarbital elixir).
• A syrup is an aqueous solution thickened
with sugar and often used to mask taste of
pediatric medications.
© Paradigm Publishing, Inc.
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Liquid Dosage Forms
Safety Note
Syrups should be used cautiously in
diabetic patients because of high
sugar content.
© Paradigm Publishing, Inc.
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Solutions
• An extract is a potent dosage derived from
animal or plant sources, with most of the
solvent having been evaporated.
• A fluidextract is a liquid dosage extracted
from plants and commonly used in syrups
(such as vanilla).
• A tincture is an alcoholic or hydroalcoholic
solution of plant extractions (such as
iodine).
© Paradigm Publishing, Inc.
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Solutions
Other solutions include
– Spirits, such as camphor or peppermint
spirit
– Irrigation solutions, used to cleanse the
ear, eye, or wounds and incisions
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Terms to Remember
spirit
an alcoholic or hydroalcoholic solution
containing volatile, aromatic ingredients
irrigating solution
any solution used for cleansing or
bathing an area of the body, such as the
eyes or ears
© Paradigm Publishing, Inc.
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Solutions
Solutions are sometimes classified by their
site or method of administration:
–
–
–
–
–
–
–
–
–
–
–
Topical (local)
Systemic (throughout the body)
Epicutaneous (on the skin)
Percutaneous (through the skin)
Oral (by mouth)
Otic (by ear)
Ophthalmic (by eye)
Parenteral (by injection)
Rectal (by rectum)
Urethral (by urethra)
Vaginal (by vagina)
© Paradigm Publishing, Inc.
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Terms to Remember
parenteral solution
a product that is prepared in a sterile
environment for administration by
injection
© Paradigm Publishing, Inc.
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Dispersions
• In a dispersion, medication is
distributed throughout the vehicle but
is not totally dissolved.
• A suspension is the dispersion of an
undissolved solid in a liquid.
• Suspensions are useful for those who
may have difficulty swallowing solid
forms.
© Paradigm Publishing, Inc.
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Dispersions
Safety Note
The drug stock bottles of liquid
suspensions and emulsions for oral
use should always be shaken well
by pharmacy technicians before
being poured into smaller
medication bottles.
© Paradigm Publishing, Inc.
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Dispersions
• Colloids have properties between a
solution and a fine suspension. Milk of
magnesia and Aveeno (with colloidal
oatmeal) are examples.
• Microemulsion contains one
liquid dispersed in another,
such as Haley’s M-O and
Compound W.
© Paradigm Publishing, Inc.
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Terms to Remember
colloid
the dispersion of ultrafine particles in a
liquid formulation
© Paradigm Publishing, Inc.
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Terms to Remember
magma
a milklike liquid colloidal dispersion in
which particles remain distinct, in a twophase system (e.g., milk of magnesia)
microemulsion
a clear formulation that contains one
liquid of extremely fine sized droplets
dispersed in another liquid (e.g., Haley’s
M-O)
Inhalation Dosage Forms
• Inhalations are inhaled through the
nose or mouth.
• Dosages can be delivered via spray
or aerosol.
• Inhalations are often used to treat
allergies and asthma.
© Paradigm Publishing, Inc.
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Terms to Remember
spray
the dosage form that consists of a
container with a valve assembly that,
when activated, emits a fine dispersion
of liquid, solid, or gaseous material
aerosol
a pressurized container with propellant
used to administer a drug through oral
inhalation into the lungs
© Paradigm Publishing, Inc.
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Transdermal Dosage Forms
• Delivers drug to the bloodstream by
absorption through the skin
• Transdermal patch consists of
– Backing
– Drug reservoir
– Control membrane
– Adhesive layer
– Protective strip
© Paradigm Publishing, Inc.
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Transdermal Dosage Forms
• Absorption occurs slowly.
• Effects last 24 hours to 1 week.
• Used to deliver
– Nicotine (smoking cessation)
– Nitroglycerine (chest pain)
– Narcotic analgesics (chronic pain)
– Scopolamine (motion sickness)
© Paradigm Publishing, Inc.
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Terms to Remember
transdermal dosage form
a formulation designed to deliver a
continuous supply of drug into the
bloodstream by absorption through the
skin via a patch or disk
© Paradigm Publishing, Inc.
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Routes of Administration
• Route of administration is a way to
get a drug into or onto the body.
• Routes can produce a systemic effect
or a local effect.
© Paradigm Publishing, Inc.
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Terms to Remember
route of administration
a way of getting a drug onto or into the
body, such as orally, topically, or
parenterally
oral route of administration
the administration of medication through
swallowing for absorption along the GI
tract into systemic circulation
© Paradigm Publishing, Inc.
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Routes of Administration
Some routes produce a systemic effect:
– Oral (by mouth)
– Sublingual (under the tongue)
– Buccal (between gum and cheek)
© Paradigm Publishing, Inc.
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Terms to Remember
systemic effect
the distribution of a drug throughout the
body by absorption into the bloodstream
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Terms to Remember
sublingual route of administration
oral administration in which a drug is
placed under the tongue and is rapidly
absorbed into the bloodstream
buccal route of administration
oral administration in which a drug is
placed between the gum and the inner
lining of the cheek; also called
transmucosal route of administration
© Paradigm Publishing, Inc.
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Routes of Administration
Other routes produce a local effect:
– Topical (on the skin)
– Intrarespiratory (inhaled into the lungs)
– Ocular (to the eye)
– Conjunctival (to the lining of the eyelid)
– Otic (to the ear canal)
– Nasal (to the nose)
– Rectal (to the rectum)
– Vaginal (to the vagina)
– Urethral (to the urethra)
© Paradigm Publishing, Inc.
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Terms to Remember
topical route of administration
the administration of a drug on the skin
or any mucous membrane such as the
eyes, nose, ears, lungs, vagina, urethra,
or rectum; usually administered directly
to the surface of the skin
local effect
the site-specific application of a drug
© Paradigm Publishing, Inc.
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Terms to Remember
intrarespiratory route of administration
the administration of a drug by inhalation
into the lungs; also called inhalation
ocular route of administration
the placement of ophthalmic
medications into the eye
© Paradigm Publishing, Inc.
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Terms to Remember
conjunctival route of administration
the placement of sterile ophthalmic
medications in the conjunctival sac of
the eye(s)
otic route of administration
the placement of solutions or
suspensions into the ear
© Paradigm Publishing, Inc.
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Terms to Remember
nasal route of administration
the placement of sprays or solutions into
the nose
rectal route of administration
the delivery of medication via the rectum
Terms to Remember
vaginal route of administration
the administration of a drug by
application of a cream or insertion of a
tablet into the vagina
urethral route of administration
the administration of a drug by insertion
into the urethra
© Paradigm Publishing, Inc.
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Routes of Administration
• Some medications must be
administered via the parenteral route
because their molecules are too large
or are broken down too quickly.
• Drugs are distributed systemically by
injection or catheter.
© Paradigm Publishing, Inc.
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Terms to Remember
parenteral route of administration
the injection or infusion of fluids and/or
medications into the body, bypassing the
GI tract
injection
the administration of a parenteral
medication into the bloodstream,
muscle, or skin
© Paradigm Publishing, Inc.
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Advantages and Disadvantages
of the Oral Route
Advantages
– Convenient
– Easy to tolerate
– Safe
– Simple to administer
– Fractional doses can be taken by
splitting scored tablets
© Paradigm Publishing, Inc.
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Advantages and Disadvantages
of the Oral Route
Disadvantages
– Delayed onset
– Destruction of the drug by GI fluids
– Delayed absorption due to food and
drink in the stomach
– For liquids, potential unpleasant taste
– For controlled-release formulations,
cannot be split or crushed
© Paradigm Publishing, Inc.
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Advantages and Disadvantages
of the Oral Route
Safety Note
The oral route is not appropriate for
patients who are experiencing
nausea or vomiting.
© Paradigm Publishing, Inc.
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Dispensing and Administering
Oral Medications
Pharmacists should tell patients
– What foods to take or not take
– What behaviors to avoid (sun, driving)
– Methods for swallowing pills
– How to store medications
© Paradigm Publishing, Inc.
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Dispensing and Administering
Oral Medications
Measuring utensils are often dispensed
with the medications:
– Spoons
– Cups
– Oral syringes
(for pediatric meds)
– Droppers
(for infant meds)
© Paradigm Publishing, Inc.
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Terms to Remember
oral syringe
a needleless device for administering
medication to pediatric or older adult
patients unable to swallow tablets or
capsules
dropper
a measuring device used to accurately
dose medication for infants
© Paradigm Publishing, Inc.
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Advantages and Disadvantages
of the Topical Route
Generally, the topical route
– Works quickly
– Produces a therapeutic effect that is
localized
– Provides fast relief
– Has fewer side effects than with a
systemic medication
© Paradigm Publishing, Inc.
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Advantages and Disadvantages
of the Topical Route
• Ointments
– Good for extremely dry areas
– Greasy feel
• Transdermal
– Steady level of drug, good compliance
– Costly, occasional skin irritation
© Paradigm Publishing, Inc.
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Advantages and Disadvantages
of the Topical Route
Inhalation
– Fast acting, delivers metered dose
– Often poor technique by patient
© Paradigm Publishing, Inc.
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Terms to Remember
metered-dose inhaler (MDI)
a device used to administer a drug as
compressed gas through the mouth into
the lungs
© Paradigm Publishing, Inc.
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Terms to Remember
diskus
a nonaerosolized powder used for
inhalation
nebulizer
a device used to deliver medication as a
mist to the lungs; often used in treating
asthma
Advantages and Disadvantages
of the Topical Route
• Vaginal and urethral
– Higher concentration of medication
– Inconvenient and messy to use
• Rectal
– Bypasses digestive system, good for
nauseous patients
– Inconvenient to use, may cause
discomfort
© Paradigm Publishing, Inc.
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Dispensing and Administering
Topical Medications
Ointments, creams, lotions, and gels
– Might require use of gloves to avoid too
much drug absorption (nitroglycerin gel)
or to avoid irritation (capsaicin)
– Might need to be applied sparingly to
avoid side effects (corticosteroids)
© Paradigm Publishing, Inc.
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Dispensing and Administering
Topical Medications
Transdermal patches
– Site must be relatively free of hair and
scar tissue.
– Rotate application site.
– Follow patch replacement schedule.
© Paradigm Publishing, Inc.
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Dispensing and Administering
Topical Medications
Ophthalmic medications
– Should be at or near room or body
temperature
– Must be stored properly
– Should be applied with clean hands
– Should be applied
with proper technique
for dispensing drops
or ointment into eye
© Paradigm Publishing, Inc.
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Dispensing and Administering
Topical Medications
Otic medications
– Should be at or near room or body
temperature
– Should be applied
with proper
technique to
ensure medication
reaches target
© Paradigm Publishing, Inc.
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Dispensing and Administering
Topical Medications
Safety Note
Eardrops can never be used in the
eye, but eyedrops can be used in
the ear.
© Paradigm Publishing, Inc.
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Dispensing and Administering
Topical Medications
Nasal medications
– Nasal medications are applied by drops
(instillation), sprays, or aerosols.
– Proper technique is key to avoid sniffing
medication into sinuses.
– Patients must not overuse OTC nasal
decongestants.
© Paradigm Publishing, Inc.
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Dispensing and Administering
Topical Medications
Inhaled medications
– Proper technique must be followed to ensure
that medication reaches the lungs.
– With cortisone MDIs, patient
should rinse mouth after
application to avoid fungal
infections.
– Spacer devices can be
used with inhalers for
children.
© Paradigm Publishing, Inc.
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Dispensing and Administering
Topical Medications
Vaginal medications
– The vaginal route is indicated for infections or
hormone replacement.
– Creams and ointments are often delivered via
applicator tube.
– For contraception, hormones can
be delivered via a ring
surrounding the cervix.
– Intrauterine devices can
deliver medication for
contraception or cancer
treatment.
© Paradigm Publishing, Inc.
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Dispensing and Administering
Topical Medications
Rectal medications
– Patients should be instructed to remove
wrappers before using.
– Patients should be instructed on proper
orientation of suppository before
insertion.
– Proper technique should be followed
when administering enemas.
© Paradigm Publishing, Inc.
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Dispensing and Administering
Topical Medications
Safety Note
Refrigeration is necessary to store
most rectal medications.
© Paradigm Publishing, Inc.
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Advantages and Disadvantages
of the Parenteral Route
Advantages
– Can deliver high concentrations of medication at once or over long period of time
– Can be
administered
to almost any
organ or part of
the body
– Acts quickly
© Paradigm Publishing, Inc.
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Advantages and Disadvantages
of the Parenteral Route
Disadvantages
– Possible injury from needle insertion
– Potential for introducing toxic agents into
the body
• Microbes
• Pyrogens
– Must be administered carefully to avoid
introduction of air bubbles or particulates
© Paradigm Publishing, Inc.
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Terms to Remember
intravenous (IV) infusion
the process of injecting fluid or
medication into the veins, usually over a
prolonged period of time
pyrogen
a fever-producing by-product of
microbial metabolism
© Paradigm Publishing, Inc.
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Dispensing and Administering
Parenteral Medications
• Parenteral medications consist of
active ingredients dissolved in sterile
water or saline.
• Injections must be given by a trained
healthcare professional.
© Paradigm Publishing, Inc.
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Dispensing and Administering
Parenteral Medications
• A syringe is used to draw up,
measure, and deliver medication.
• The cannula is the bore area inside
the syringe.
© Paradigm Publishing, Inc.
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Dispensing and Administering
Parenteral Medications
Intravenous injections or infusions
– Can deliver a variety of medications or
other substances
– Usually administered in the superficial
veins of the arm
– Infusion pumps can deliver medication
24/7 or can be controlled by the patient
© Paradigm Publishing, Inc.
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Dispensing and Administering
Parenteral Medications
Intravenous injections or infusions
© Paradigm Publishing, Inc.
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Terms to Remember
patient-controlled analgesia (PCA)
infusion device
a device used by a patient to deliver
small doses of medication for chronic
pain relief
© Paradigm Publishing, Inc.
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Dispensing and Administering
Parenteral Medications
Safety Note
Only the patient should control the
PCA pump button.
© Paradigm Publishing, Inc.
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Dispensing and Administering
Parenteral Medications
Intramuscular injections
– Can deliver a variety of medications or
other substances
– Volume limited to 2 to 3 mL
– Injection site usually gluteus maximus (in
adults) or deltoid (in children)
© Paradigm Publishing, Inc.
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Dispensing and Administering
Parenteral Medications
Intramuscular
injections
© Paradigm Publishing, Inc.
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Dispensing and Administering
Parenteral Medications
Subcutaneous injections
– Medications are administered below the
skin to the subcutaneous tissue.
– Insulin is the most common type of
subcutaneous injection:
• Insulin must be stored and prepared properly.
• Patients must know proper method for
injecting.
– Subcutaneous injections are also used for
epinephrine and heparin.
© Paradigm Publishing, Inc.
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Dispensing and Administering
Parenteral Medications
Safety Note
The patient should be instructed to
agitate but not shake the insulin
vial.
© Paradigm Publishing, Inc.
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Dispensing and Administering
Parenteral Medications
Subcutaneous injections
© Paradigm Publishing, Inc.
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Dispensing and Administering
Parenteral Medications
Intradermal injections
– Injected into the layer just below the
epidermis
– Used for
• Local anesthesia
• Immunizations
• Diagnostic tests (tuberculosis, allergy testing)
© Paradigm Publishing, Inc.
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Dispensing and Administering
Parenteral Medications
Intradermal injections
© Paradigm Publishing, Inc.
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